Reference Form for Senior Scientist Membership Applicants All fields are required Please enter the Sponsor's information: Please indicate the name of the person applying for membership: is applying for Senior Scientist membership status in the Society of NeuroInterventional Surgery and has listed you as a reference. Senior Scientist questionnaire: 1. How long have you known the applicant? 2. During what time period has the applicant had active scientific contribution to the field of NeuroInterventional Surgery? Do you feel that the applicant is AcceptableUnacceptable as a Senior Scientist Member of SNIS?